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Fewer stress tests performed after PCI
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Fewer stress tests are being performed after PCI, but caution should be paid to unintended consequences such as limiting access for patients with legitimate testing needs, study results indicated.
In the study, researchers linked CathPCI Registry data to Medicare claims to measure stress testing from 60 to 365 days after PCI and procedures within 90 days after testing among patients (n=284,971) who received PCI with stent insertion, were at least 65 years of age and were admitted and discharged between 2005 and 2008.
The overall stress testing rate after PCI was 53.1 per 100 person-years, but the rates had fallen from 59.3 in 2006 to 47.1 by the end of 2008. Stress test modalities fell proportionally.
Among exercise testing recipients, those receiving electrocardiography-only testing varied from 6.8% to 22.8% across census divisions. Among patients who also underwent an imaging test, those who received echocardiography compared with nuclear imaging varied from 9.4% to 34.1%.
Exercise electrocardiography-only testing was associated with more subsequent stress testing (13.7% vs. 2.9%; P<.001), but less catheterization (7.4% vs. 14.1%; P<.001) than imaging-based tests.
Researchers said patients receiving imaging studies had more subsequent procedures than patients receiving ECG-only testing, possibly because of more challenging interpretation of ECG-only stress tests or less physician confidence in results. There were geographic variations, as well, possibly due to local thought leaders having an influence on their peers or differences in availability.
Finally, the overall decline in stress testing coincided with reimbursement cuts, criteria for appropriate use released by the American College of Cardiology Foundation and increased attention to overuse, they wrote.
“These findings suggest there would be value in determining more precisely the optimal use of stress test modalities after PCI in individual patients,” the researchers wrote.
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